Incidence (epidemiology)

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Incidence is a measure of the risk of developing some new condition within a specified period of time. Although sometimes loosely expressed simply as the number of new cases during some time period, it is better expressed as a proportion or a rate with a denominator.

Incidence proportion (also known as cumulative incidence) is the number of new cases within a specified time period divided by the size of the population initially at risk. For example, if a population initially contains 1,000 non-diseased persons and 28 develop a condition over two years of observation, the incidence proportion is 28 cases per 1,000 persons, i.e. 2.8%.

The incidence rate is the number of new cases per unit of person-time at risk. In the same example as above, the incidence rate is 14 cases per 1000 person-years, because the incidence proportion (28 per 1,000) is divided by the number of years (two). Using person-time rather than just time handles situations where the amount of observation time differs between people, or when the population at risk varies with time.^[1] Use of this measure implicitly implies the assumption that the incidence rate is constant over different periods of time, such that for an incidence rate of 14 per 1000 persons-years, 14 cases would be expected for 1000 persons observed for 1 year or 50 persons observed for 20 years.

When this assumption is substantially violated, such as in describing survival after diagnosis of metastatic cancer, it may be more useful to present incidence data in a plot of cumulative incidence over time, taking into account loss to follow-up, using a Kaplan-Meier Plot.

Incidence should not be confused with prevalence, which is a measure of the total number of cases of disease in a population, rather than the rate of occurrence of new cases. Thus, incidence conveys information about the risk of contracting the disease, whereas prevalence indicates how widespread the disease is.

For example, consider a disease that takes a long time to cure, and that was spread widely in 2002, but whose spread was arrested in 2003. This disease will have a high prevalence and a high incidence in 2002; but in 2003 it will have a low incidence, although it will continue to have a high prevalence because it takes a long time to cure. In contrast, a disease that has a short duration may have a low prevalence and a high incidence.

When studying etiology of a disease, it is better to analyse incidence rather than prevalence, since prevalence mixes in the duration of a condition, rather than providing a pure measure of risk.